posted

30+ days ago

Location

St Louis Park, MN

Description

Job Description:

HealthPartners has an exciting part time RN Worker’s Compensation and Disability Case Manager, Worksite Health. This role provides case management services to employers and employees contracted with the HealthPartners Work Site Health.  Case management’s goal is to ensure appropriate use of medical resources to facilitate optimal medical care including optimal timing of return to work for employees of companies contracting with HealthPartners Worksite Health.

At HealthPartners, you will find a culture of excellence, compassion, integrity and most importantly, partnership. By working together, we will improve health, create exceptional experiences for those we serve and make care and coverage more affordable.

ACCOUNTABILITIES:

1. Case Management:

  • Collects and evaluates pertinent medical information in a timely manner, acts on that data to ensure high quality medical care, including the appropriate early return to functional activity of the monitored patient.  Develops and implements case management goals and objectives consistent with the treatment and return to work plan.
  • Identifies in a timely manner, tracks and monitors all injured worker cases.
  • Categorizes cases into stratified levels of case management intervention using established criteria.
  • Identifies cases that deviate from standards of care for medical or disability care delivery and intervenes on such cases in a timely manner to bring the care in line with standards of care, or documents medical necessity for the deviation.
  • Maintains good working relationships with other case managers and the Medical Director.

2. Communication and Education:

  • Provides timely and complete communication to providers, employee/patients, and employers concerning medical decisions, deviations from standard of care, and applicable guidelines, using education as the preferred method of addressing discrepancies by the various customers.
  • Uses established criteria such as ICSI, MN, DOLI treatment guidelines, Presley Reed, Milliman and Robertson as teaching tools for the providers as appropriate for individual cases.  Educates network providers to pro-actively involve case management services in potentially complicated cases.
  • For Worker’s Compensation Managed Care plan (WC MCP), approves and monitors “out of network” provider referrals and medical service delivery of “out of network” providers required WC MCP materials to “out of network” providers.
  • Communicates with key customers (e.g., providers, payers, employees, employers, and QRCC (if assigned)) to ensure they understand the rationale behind case management decisions.
  • Ensures timely Return to Work (RTW) form completion and facilitates communication of this and other required medical records to the employer and payer for expediting RTW planning, compensibility determination and payment of claims.
  • Involves the medical director in a timely manner on specific cases, based on mutually developed criteria.
  • For WC MCP, assists administrative staff in meeting with designated employer contacts as required to assess occupational health needs and develop customized plans to meet their needs for successful workers’ compensation managed care.  Includes participating in establishing supervisor training plan and communication procedures, reviewing job descriptions, Return to Work (RTW) plans, and assessing worksite for safety and ergonomic concerns.
  • For WC MCP, assists administrative staff as needed with onsite pre-implementation instruction and training sessions to managers and supervisors.  Information covered includes outlining employer responsibilities including employee notification according to the Workers Compensation Managed Care Rules.

3. Medical Resource Management:

  • Ensures timely, appropriate and efficient use of medical resources, diagnostic testing, subspecialty referral, ergonomic evaluation, second opinion and adversarial examinations while facilitating early return to functional activity of the monitored patient.
  • Facilitates moving the employee through the health care system and achieving timely implementation of treatment plan.
  • Works with providers as an advocate and partner to negotiate treatment plans as needed to obtain “win-win” outcomes.
  • Negotiates with employers and/or direct supervisors to facilitate early RTW.
  • Ensures goal oriented medical treatment plans that reflect subjective, objective and functional outcomes and that are consistent with ICSI, MN. DOLI, HealthPartners guidelines, etc.
  • Intervenes in cases where treatment deviates from standards of care to bring them in line or document medical necessity.

4. Tracking and Reporting:

  • Provides regular reports including type of disability, length of time off, limited duty time, and dedicate outcome using the patient, provider and employer as appropriate in order to identify trends that can be analyzed for implementing strategies to reduce workplace injuries/illness and associated cost.
  • Provides information in a timely manner as required to employers and/or payer to expedite billing and claims payment, adjudication, utilization review, and for tracking and reporting purposes.
  • Uses computer tracking system, which serves as the medical record and provides data for reporting purposes.
  • Provides regular reports as required to employers and/or payers.

REQUIRED QUALIFICATIONS:

  • Registered Nurse with current Minnesota nursing license.
  • Three years’ experience in related nursing field (e.g., occupational health, emergency medicine, etc.) including at least two years’      experience in worker’s compensation case management.
  • Demonstrated current working knowledge of the Minnesota Workers’ Compensation rules and systems including Workers’ Compensation Statutes, and Treatment Parameters.
  • Demonstrated current working knowledge of Managed Care Rules as well as OSHA, ADA, FMLA if applicable.
  • Demonstrated expertise in outpatient disability case management.
  • Strong computer skills using Microsoft Word and Excel or similar applications.
  • Excellent oral and written communication skills
  • Strong negotiation skills
  • Strong time management and organizational skills
  • Strong complex problem-solving skills.
  • Knowledgeable and resourceful in developing community resource network.
  • Demonstrated ability to work in collaborative fashion with other case management team members.

HealthPartners offers a comprehensive benefits package. To see a complete job description and/or to apply for this position, please visit www.healthpartners.com/careers, click on job opportunities and search for Job ID #57062.

       

Additional Information: